Illness Is a Weapon: Indigenous Identity and Enduring Afflictions

6. Imposed Empowerment

ChApteR 6 Imposed Empowerment D espite the existence of comprehensive health care facilities throughout economically developed nations, Indigenous residents continue to suffer from poorer health than non-Indigenous residents . The sporadic and unsuccessful utilization of clinics and hospitals is often attributed to cultural difference and marginality. Because many health services were set up by non-Indigenous governments, are run by non-Indigenous people, and rely on non-Indigenous protocols, it is believed that they are capable of confusing and alienating Indigenous people. To redress the pervasive inequities of treatment, health care initiatives have begun to stress the importance of Indigenous empowerment within a clinical care environment. Empowerment is commonly defined as the process through which individuals, groups, or communities are able to gain increased knowledge and power about decisions and actions affecting their lives. By granting a greater role to Indigenous knowledge, practitioners and ways of life, it is hoped that health care will be utilized more regularly and effectively. Around the globe Indigenous empowerment through and within health care has become a principal objective. In the United States, medical professionals are urged to address the “cultural barriers to help empower Native American patients” (Oropeza 2002, 1). During his keynote address at the Te Ohu Rata o Aotearoa Māori Medical Practitioners Association Conference, Dr. Mason Durie (2009) urged Māori health leadership to “transform health care into health empowerment.” These appeals seek not only improved health outcomes, but also an acknowledgement of social and cultural difference. Empowerment is a strategy for well-being and self-determination that explicitly combines medicine and the politics of Indigeneity. Consequently, understanding the creation , management, and outcomes of these initiatives illustrates the complex relationships between state governments, health professionals, and Indigenous people. 120 In Australia, widespread dissatisfaction with government health services , living conditions, and economic opportunities has led to repeated calls for Aboriginal empowerment and self-determination. Projects promoting self-determination are often firmly grounded in the belief of cultural exceptionalism, which cast Aboriginal people as fundamentally different (Christen 2009, 8; Cowlishaw 2010, 53). Beginning in the 1970s, increasing attention was focused on improving health through greater Aboriginal involvement in health services. One of the largest results of this effort was the introduction and expansion of the Aboriginal Health Worker Program, which seeks to train and employ Aboriginal people as clinicians working alongside nurses. By the 1980s, notions of self-determination led to the widespread assumption that Aboriginal people would eventually control many aspects of service provision (Christen 2009). In providing Aboriginal people greater input into the delivery of medical care, community controlled clinics have been subsequently indorsed by governments, health care professionals, and Aboriginal people. Although the Aboriginal Health Worker Program and community controlled clinics seek to increase Aboriginal participation in the health care sector and provide culturally appropriate treatment, they are driven by two different approaches. Modeled after the World Health Organization’s village health workers program, the Aboriginal Health Worker Program seeks to combine Aboriginal and non-Aboriginal perspectives . To produce culturally and clinically effective service, the program attempts to promote equality between Aboriginal health professionals and nursing staff. In contrast, community control withdraws participant clinics from government management, allowing them to be run by an Aboriginal board. Community control “braids together calls from Aboriginal advocates for greater autonomy in running Aboriginal health services with a government desire to in fact have less responsibility for (difficult and often futile) arenas of direct service delivery” (Lea 2008, 41). Instead of working in tandem with the governmental health system, Aboriginal people are encouraged to develop their own independent facilities and services. In Lajamanu, the clinic offers employment to Aboriginal Health Workers and has been community controlled by the Katherine West Health Board since 1998. Despite the goals of equity, empowerment, IMposed eMpoWeRMeNt 121 and better health service provision, the operation of clinic has changed very little. Nurses and patients continued to have disagreements. Many of the stories related in the previous chapter occurred while the clinic was under community control. Aboriginal Health Workers were often dissatisfied with the attitudes and behaviors of non-Aboriginal medical staff and some preferred to be unemployed rather than work at the clinic. Non-Aboriginal medical staff, initially optimistic that Aboriginal control would make a difference, frequently left complaining that Warlpiri people did not show an interest in “taking over” the clinic. If community control was intended to bring about improvements in medical service delivery within...